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A psychiatrist who prescribed medications for Ashley Smith while the teen was an inmate at Joliette prison in Quebec, testified she was unaware the injections were being given without the 19-year-old’s consent.

Dr. Michele Roy says she was unaware Ashley Smith didn't give consent to the injections of powerful drugs she receieved in a Quebec jail in July 2007. (Donovan Vincent / Toronto Star) | Order this photo

A psychiatrist who prescribed medications for Ashley Smith while the teen was an inmate at Joliette prison in Quebec testified she was unaware the injections were being given without the 19-year-old’s consent.

Dr. Michele Roy testified she was “disturbed” a few weeks ago after seeing the videos of the July 2007 injections for the first time. In her view, nothing on the videos warranted giving Ashley medications without consent, the psychiatrist told the inquest.

“It was quite disturbing for me . . . it was the first time I realized the discrepancy between what I was told (at the time) and the reality of Ashley’s (behaviour) at Joliette,” Roy told the inquest examining Smith’s self-asphyxiation death in October 2007 at a Kitchener prison.

The most controversial of the videos shows Smith being injected five times in about seven hours on July 22, 2007 while tied down on a restraint bed as she’s surrounded by guards in riot gear and nurses. Smith can be heard on the video several times saying “no” to the medications.

Roy prescribed the restraints and injections after Smith was seen by prison staff putting metal objects in one of her body cavities, and blood was seen on her prison gown and on the floor in her segregation cell at Joliette. There was a concern that Smith could harm herself.

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But Roy, a psychiatrist with expertise in mentally ill inmates, said the videos show Smith wasn’t in the “severe state of agitation” nurses described on the phone that day. Roy was on call and not in the prison at the time.

The inquest heard the injections included powerful anti-psychotic drugs that can also be used as sedatives. Roy testified she prescribed the drugs for the latter purpose, to calm Ashley down.

Last week Melanie Boucher, a nurse at Joliette who gave Smith four of the five injections the teenager received that day, testified Roy ordered “chemical and physical restraints” for Ashley because Smith was very agitated and hiding the metal inside herself. The goal was to get Ashley to a hospital, where she could be given a body cavity search, Boucher testified.

The injection prescriptions continued that day amid ongoing reports to Roy from Boucher and other nurses that Ashley was very agitated and not settling.

The inquest heard yesterday that individuals can be given medications against their will if they lack the capacity to decide due to mental disorder, or in an emergency where there’s an acute risk of death or serious harm.

Boucher testified earlier that the issue of Smith’s consent to treatment “didn’t enter the picture” in discussions with Roy because it was feared Smith could harm herself with the hidden objects, and was out of control.

Louise Geoffroy, another Joliette nurse, testified Monday that Smith didn’t have the capacity to give consent before being injected the next day, July 23, 2007, and Geoffroy said she didn’t discuss consent with Roy prior to administering the drugs that day.

Roy testified she expected the drugs she prescribed to be administered “immediately’’ but assumed the nurses were getting consent from Ashley first, which she said is the normal way of doing things. Roy said she wasn’t aware the injections were being administered without Smith’s consent, and attributed the problem to the nurses — her “eyes and ears on the ground’’ — being unaccustomed to dealing with such a complex case as Ashley. The inquest has been told Smith had a borderline personality disorder.

Julian Roy, the lawyer for the Smith family at the inquest, suggested to Dr. Roy (no relation) that when she made her orders she “turned her gaze away’’ and left the consent issue to the nurses to “deal with.’’

The doctor vehemently disagreed, saying she would never “hide behind’’ her nurses.

The physician referred to circumstances involving Ashley that occurred July 16, 2007 at the prison.

In that earlier case another nurse contacted Roy to say Smith was harming herself. Roy prescribed restraints and an injection, but when the nurse told Roy that Smith wasn’t consenting to drugs, the nurse and Roy came up with an alternate plan to give Ashley different medications orally with her consent.

“The problem on (July 22, 2007) was that I wasn’t informed she (Smith) was refusing the medication,’’ Roy testified.

The injection incidents are being explored by the inquest because they may speak to Ashley’s state of mind at the time of her death, the inquest has heard.

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